Chronic anemia as a complication of parvovirus B19 infection in a pediatric kidney transplant patient

. This is a report of unexplained anemia that persisted for 4 months in an adolescent renal transplant patient receiving immunosuppression that included prednisone, tacrolimus, and mycophenolate mofetil. This patient required monthly blood transfusions for fatigue, palpitations, and hematocrit levels between 15% and 17%. In addition, his posttransplant course was notable for the development of insulin-dependent diabetes mellitus. While receiving low-dose prednisone, he was switched from tacrolimus to cyclosporin and tapered off insulin injections over the next 2 months. At 4.5 months post-transplantation, further diagnostic evaluation was suggestive of parvovirus B19 infection as the cause for our patient’s chronic anemia. After testing negative for serum-specific parvovirus B19 IgM and IgG antibodies, parvovirus B19 infection was detected in blood by the polymerase chain reaction. Treatment with intravenous immunoglobulin (1 g/kg per day × 2 days) resulted in normalization of both his reticulocyte count and hematocrit within 6 weeks. At 4 months after receiving the immunoglobulin infusion, he has maintained a normal hematocrit level and stable renal function without requiring further blood transfusions. Received August 23, 1996; received in revised form and accepted November 20, 1996     

Peripancreatic lymphoadenopathy and extrahepatic immunological manifestations in chronic hepatitis C

Abstract. The aim of the study was to determine the role of peripancreatic lymph node swelling in systemic immunological alterations during chronic hepatitis C (HC). The prospective study was carried out as a clinical study in a university hospital. Clinical, haematochemical and ultrasonographic findings in 182 patients were studied. Ultrasonography was performed by the same operator and the findings were evaluated blind without the operator knowing the clinical and haematochemical parameters. Hepatitis B virus (HBV) markers, anti-HCV antibodies. LKMl, cryoglobulinaemia, rheumatoid factor and anti-tissue antibodies were determined. Liver biopsy was carried out in 43 of the 182 patients. One or two pathological peripancreatic lymph nodes (PLNs) were present in 30 of the 182 patients and, of the 30, 28 were anti-HC positive. Only one patient in the non-PLN group was positive for anti-HCV, there being statistical significance ( P <0.0001) between the PLN and non-PLN groups. In HCV-positive patients, extrahepatic immunological manifestations were observed (cryoglobulinaemia; positivity to anti-smooth muscle, antinuclear and antimitochondrial antibodies; positivity to rheumatoid factor and LKMl). In five patients the presence of focal lymphocytic aggregates was detected by biopsy, whereas one patient presented typical ocular lesion of Mikulicz's syndrome. Our results may confirm the marked lymphotropism shown by the HC virus and indicate more complex immune system involvement, especially in view of the coexisting signs of immune system involvement related to the presence of intrahepatic cellular aggregates detected in our study. We believe that the peripancreatic adenopathy in chronic HCV hepatitis is an important diagnostic sign and may indicate an involvement of the C virus in the still unexplained extrahepatic immunological disorders.     

儿童慢性轻度哮喘治疗的临床研究

目的　探讨 3～ 8岁儿童慢性轻度哮喘的早期干预治疗方法。方法　将 12 0例 3～ 8岁慢性轻度哮喘患儿随机均分为治疗组 1、2和对照组。治疗组 1:3～ 5岁患儿口服孟鲁司特 (顺尔宁 ) 4 .0mg/d ,5～ 8岁服5 .0mg/d ,疗程 3～ 6个月 ;治疗组 2 :予口服盐酸西替利嗪 2 .5～ 5 .0mg/d ,疗程 3～ 6个月 ;对照组 :口服安慰剂。均于每日睡前服用。结果　与治疗组 2及对照组相比 ,治疗组 1的日间及夜间症状出现率、急性加重发生率、月均 β 受体激动剂使用率、峰值呼气流速 (PEF)变化、嗜酸性粒细胞计数 (EC)下降率的差异有显著性 (P <0 .0 1) ,而住院率、药物不良反应率的差异无显著性 (P >0 .0 5 )。治疗组 2与对照组EC值的差异有显著性 (P <0 .0 1) ,其余指标的差异均无显著性 (P值均 >0 .0 5 )。结论　白三烯受体拮抗剂孟鲁司特单独用于慢性轻型哮喘儿童的早期干预治疗具有疗效好、不良反应小及患儿依从性高的特点     

Brain-derived neurotrophic factor in cerebrospinal fluid of patients with chronic daily headache: relationship with nerve growth factor and glutamate levels

Little has been done to investigate the biochemical basis of chronic daily headache (CDH). Our group has recently demonstrated an increase in the cerebrospinal fluid (CSF) levels of nerve growth factor (NGF) in CDH patients, supporting the involvement of this growth factor in the abnormal processing of head pain in this pathological condition. Other members of the neurotrophin family, especially brain-derived neurotrophic factor (BDNF), have been hypothesized as being involved in the development of chronic head pain in patients affected by CDH, but so far no data are available on this subject. BDNF, NGF and glutamate levels were determined in the CSF of 25 patients affected by CDH with a previous history of migraine. These levels were compared with those of a group of 20 control subjects, for whom the CSF examination and other instrumental investigations excluded diseases of the central and peripheral nervous systems. Significantly higher levels of BDNF, NGF and glutamate were found in CDH patients compared with control subjects (p<0.0001, p<0.0002 and p<0.001, respectively). A significant positive correlation emerged between CSF values of BDNF and those of NGF (r=0.61, p<0.001) and glutamate (r=0.44, p<0.025) in CDH patients. No significant differences were detected in BDNF, NGF and glutamate levels between CDH patients with analgesic overuse and those without. These results support the involvement of BDNF in CDH through the potentiation of glutamatergic transmission involved in the processing of head pain. The significant correlation between BDNF and NGF levels suggests that NGF-mediated up-regulation of BDNF in central sites involved in long-term sensitization plays a key role in persistent head pain in CDH patients. Correspondence to P. Sarchielli     

Direct evidence for the link between monoaminergic descending pathways and motor activity:: II. A study with microdialysis probes implanted in the ventral horn of the spinal cord

In order to define precisely the relation between descending monoaminergic systems and the motor system, we measured in the ventral horn of spinal cord of adult rats the variations of extracellular concentrations of 5-HT, 5-HIAA, DA and MHPG. Measurements were performed during rest, endurance running on a treadmill, and a post-exercise period, with microdialysis probes implanted permanently for 45 days. We found a slight decrease in both 5-HT and 5-HIAA during locomotion with a more marked decrease during the post-exercise period compared to the mean of rest values. In contrast, the concentration of DA and MHPG increased slightly during the exercise and decreased thereafter. These results, when compared with those of a previous study, which measured monoamines in the spinal cord white matter [C. Gerin, D. Bécquet, A. Privat, Direct evidence for the link between monoaminergic descending pathways and motor activity: I. A study with microdialysis probes implanted in the ventral funiculus of the spinal cord, Brain Res. 704 (1995) 191–201], highlight the complex regulation of the release of monoamines that occurs in the ventral horn.     

High resolution nuclear magnetic resonance imaging of the spinal cord in experimental demyelinating disease

Summary Chronic recurrent experimental allergic encephalomyelitis was induced in a strain 13 guinea pig by inoculation of isologous spinal cord homogenate. The spinal cord was obtained after perfusion with 4% paraformaldehyde and examined with nuclear magnetic resonance (NMR) imaging. Proton NMR spin echo images (repetition time: 3 s; echo times: 20 and 60 ms) were obtained from intact, isolated spinal cord in a 4.7 Tesla, 50 mm bore magnet. The slice thickness of the images was 380 m and the inplane resolution was 40×40 m. The images showed superficial areas of low signal intensity in the lateroventral regions of the white matter, in some instances with a seam of higher signal intensity. Neuropathologically, these abnormalities corresponded exactly to areas of demyelination. Control images did not show these abnormalities. The present high resolution imaging allowed a correlation between demyelination and abnormal NMR signals in a small laboratory animal with an inflammatory demyelinating disease.Supported by the Belgian Foundation of Medical Scientific Research (FGWO, grant 3.0096.86 and grant 3.0019.86), by the Institute for the promotion of Scientific Research in Industry and Agriculture (IWONL) and by the Scientic Research Planning Office of the Belgian Government (DPWB), contract no. 87/92-120     

Biological responses to overload training in endurance sports

Summary Five subjects undertook 10 days of twice daily interval training sessions on a treadmill followed by 5 days of active recovery. On days 1, 6, 11, and 16 the subjects were required to undertake a test of submaximal and maximal work capacity on a treadmill combined with a performance test consisting of a run to exhaustion with the treadmill set at 18 km · h^–1 and 1% gradient. Also on these days a pre-exercise blood sample was collected and analysed for a range of haematological, biochemical and immunological parameters. The subjects experienced a significant fall in performance on day 11 which had returned to pretraining levels on day 16. Serum ferritin concentrations were depressed significantly from pretraining concentrations at the conclusion of the recovery period while the expression of lymphocyte activation antigens (CD25⁺ and HLA-DR⁺) was increased both after the training phase and the recovery phase. The number of CD56⁺ cells in the peripheral circulation was depressed at the conclusion of the recovery period. Several parameters previously reported to change in association with overload training failing to reflect the decrease in performance experienced by subjects in this study, suggesting that overtraining may best be diagnosed through a multifactorial approach to the recognition of symptoms. The most important factor to consider may be a decrease in the level of performance following a regeneration period. The magnitude of this decreased performance necessary for the diagnosis of overtraining and the nature of an appropriate regeneration period are, however, difficult to define and may vary depending upon the training background of the subjects and the nature of the preceding training. It may or may not be associated with biochemical, haematological, physiological and immunological indicators. Individual cases may present a different range of symptoms and diagnosis of overtraining should not be excluded based on the failure of blood parameters to demonstrate variation. However, blood parameters may be useful to identify possible aetiology in each separate case report of overtraining. An outstanding factor to emerge from this study was the difficulty associated with an objective diagnosis of overtraining and this is a possible reason why there have been new accounts of overtraining research in the literature.     

Chronic lymphocytic leukaemia: When and how to treat

Summary In the 4th International Workshop on Chronic Lymphocytic Leukaemia (CLL), staging and response criteria were proposed to help physicians make decisions on when and how to treat patients with CLL. The most important factor is prolonging survival. There are several promising new treatment approaches under investigation, and the criteria proposed should facilitate future therapy trials.Supported in part by grants 89-0353 (Fondo de Investigaciones Sanitarias de la Seguridad Social), PA 85-0234 and PB 86-0593 (Dirreción General de Investigación Científica y Técnica), Ministerio de Educación y Ciencia     

慢性低氧大鼠肾上腺皮质球状带的变化

将Ｗｉｓｔａｒ大鼠喂养在逐渐降低的常压低氧条件下，用氮气和空气的混合气体调节氧含量。氧浓度由正常逐步降低为１５％、１２％、１０％、８％，最后降至７％，实验共进行１１２ｄ，结果显示低氧动物体重下降，肾上腺重量减少，肾上腺皮质球状带萎缩，脂质丢失，球状带细胞线粒体肿胀和空泡变性，溶酶体增多，表明在慢性常压低氧中，当吸入气氧含量降至７％时，可导致肾上腺皮质球状带细胞超微结构改变，从而影响醛固酮的合成与分     

白松片对慢性应激抑郁模型大鼠行为学及血浆CORT、ACTH的影响

目的：观察白松片对慢性应激抑郁大鼠模型行为学和血浆CORT、ACTH含量的影响。方法：SD雄性大鼠28只随机分为空白对照组、模型对照组、氟西汀对照组及白松片试验组，选用慢性轻度不可预见性应激加孤养造模，观察各组大鼠敞箱实验和液体消耗等行为学指标变化，采用放射免疫方法检测大鼠血浆皮质醇(CORT)和促肾上腺皮质激素(ACTH)含量。结果：慢性应激抑郁大鼠体重增加缓慢，敞箱实验中的水平运动、垂直运动得分、清洁动作次数显著减少，中央格停留时间显著延长；糖水消耗明显下降，纯水消耗显著增多，而且其血浆皮质醇和促肾上腺皮质激素含量增加。氟西汀和白松片均显著改善慢性应激抑郁大鼠模型的行为学和神经内分泌变化。结论：慢性轻度不可预见性应激可使大鼠行为及神经内分泌发生异常改变，引起抑郁状态，白松片对此具有一定拮抗作用。